Crowns and removable bridges have often been the approach to preserving diseased teeth or replacing lost teeth. However, such devices tend to fail due to the genetic predisposition of tooth decay and periodontal disease that natural teeth cause in some high risk patients. As a result patients often experience an endless cycle of dental work, with the risk that each procedure increasingly limits dental function and compromises quality of life.
As a solution to such problems, the hybrid fixed bridge (e.g., Hybridge™ and other brands) has been developed. Such a bridge replaces all of the patient's upper and/or lower teeth. The fixed bridge is permanently supported on multiple (typ. 4 or more) dental implants and looks, feels and functions like healthy, natural teeth, and also preserves the jaw bone as a result of stimulation of the bone supporting the implants, thereby preventing bone loss and preserving facial appearance. Moreover, the disclosed process may also be used when doing a cement retained implant supported fixed bridge (not a Hybrid, and not screw retained).
It is not uncommon to utilize threaded implants to support fixed-detachable dentures and other prostheses within a patient's mouth. Also, threaded dental implants have been used to support prostheses at or shortly after the time the implants are placed. For example, P. A. Schnitman et al. (Int-J-Oral-Maxillofacial-Implants. 1997 July-August 12(4):495-503), D. P. Tarnow et al. (Int-J-Oral-Maxillofacial-Implants. 1997 May-June: 12(3):319-24) and G. Kammeter et al. (J Prosthetic Dent. 2001 May; 87(5):473-476) have all described “immediate loading” of implants. For example, the term “immediate denture” is also defined by The Academy of Prosthodontics (THE JOURNAL OF PROSTHETIC DENTISTRY; THE GLOSSARY OF PROSTHODONTIC TERMS (GPT-9), Ninth Ed., May 2017, p. e47) as “any fixed or removable dental prosthesis fabricated for placement immediately following the removal of a natural tooth/teeth” or dentition. The embodiments disclosed herein advocate placing a final, definitive prosthesis with an “early” or “progressive loading” protocol, where initially, a temporary denture is placed on the implants (the provisional) and subsequently the definitive prosthesis is placed. Loading of fixed hybrid bridges (within 2-3 weeks of surgery), using the techniques disclosed herein for immediate and early loading are believed to be more predictable, easier, more cost effective, with less steps, and more precise for a number of reasons, including the manner of preparing for (impressions, radiographic scans, etc.), simultaneously establishing tooth position, time for producing and installing temporary and definitive fixed hybrid bridges, etc. An exemplary disclosure of such a system and methodology is found, for example, in published U.S. Patent Application 2009/0081618 for a SYSTEM AND METHOD FOR IMMEDIATE LOADING OF FIXED HYBRID DENTAL PROSTHESES, by Frank R. LaMar, published Mar. 26, 2009, which is hereby incorporated by reference in its entirety. Moreover, the improved techniques and protocols for edentulous mandibles and maxillas as disclosed herein are not believed to have been previously considered or used.
The timely completion of a fixed hybrid bridge is desirable by many patients. Moreover, aspects of the hybrid bridge system and methodology, as disclosed in detail herein, provides a fixed restoration that may be preferred by many patients, provides improved masticatory function, provides improved aesthetics with ideal gingival contours, and importantly is cost effective as it only requires about five to six implants and uses a simplified technique. Most patients are candidates depending upon the quantity of bone in the symphysis of the mandible and the premaxilla of the maxilla. Once a patient is evaluated for a fixed hybrid bridge, one of the treatment protocols disclosed below may be completed in a timely manner to assure a successful outcome. Moreover, the embodiments disclosed below provide the added value of digital capture of physical patient information—such as implant location and orientation relative to bone, tissue, and teeth—as a means to substantially shorten the time, and the number of patient appointments, to design, manufacture and install a dental prosthetic(s) for a patient.
Disclosed in embodiments herein is a method of preparing and installing a fixed bridge-type dental prosthesis within a patient's mouth, comprising: inserting a plurality of dental implants into the patient's alveolar tissue (mandible or maxilla); attaching, to each of said dental implants, a tapered prosthetic shoe; temporarily affixing, to each of the prosthetic shoes, a healing sleeve having a generally cylindrical outer surface on a first end of the healing sleeve and a tapered interior surface on a first end, said tapered interior surface matching the taper of the prosthetic shoes when said healing sleeves are placed thereon, wherein said healing sleeves prevent the post-implant overgrowth of gingival tissue over the implants; and capturing a radiographic image of the patient's mouth, said captured image including representations of alveolar tissue and gingival tissue as well as each tissue level implant and at least an associated prosthetic shoe. In accordance with a further aspect of the disclosed embodiments, the healing sleeves may be radiographically translucent, which provides the ability to take a digital radiographic image of the underlying prosthetic shoe (affixed to the implant) immediately after surgery and thereby facilitate the accurate and immediate manufacture of the dental prosthetic.
As part of disclosed embodiments, the prosthetic shoes are initially attached to implants to facilitate imaging, design of a prosthesis, and the installation of healing sleeves after implants are installed, and then the shoes (or identical equivalents) end up being the means by which the full prosthesis is attached to the implants. In other words the prosthetic shoes are adhered to and become an integral part of the prosthesis.
The various embodiments described herein are not intended to limit the disclosure to those embodiments described. On the contrary, the intent is to cover all alternatives, modifications, and equivalents as may be included within the spirit and scope of the various embodiments and equivalents set forth. For a general understanding, reference is made to the drawings. In the drawings, like references have been used throughout to designate identical or similar elements. It is also noted that the drawings may not have been drawn to scale and that certain regions may have been purposely drawn disproportionately so that the features and aspects could be properly depicted.